1

1.0 Declaration of Alma Ata

International Conference on Primary Health Care,
USSR, 6-12 September 1978

The International conference on Primary Health Care , meeting in Alma Ata this twelfth day
of September in the year Nineteen hundred and Seventy – eight, expressing the need for
urgent action by all governments, all health and development workers and world community
to protect and promote the health of all the people of the world, hereby makes the following

Declaration:
I. health:
the conference strongly reaffirms that health, which is a state of complete physical, mental
social wellbeing and not merely the absence of disease or infirmity, is a fundamental human
right and that the attainment of highest possible level of health is a most important world-
wide social goal whose realization requires the action of many other economic sectors in
addition to the health sectors.

II. Equity: The existing gross inequality in the health status of the people particularly
between developed and developing counties as well as within countries in politically
socially and economically unacceptable and is, therefore, of common concern to all
countries.
III. Economic and social development, based on a new International Economic Order, is
of basic importance to the fullest attainment of health for all and to the reduction of
the gap between the health status of the developing and developed countries. The
promotion and protection of the health of the people is essential to sustained
economic and social development and contributes to a better quality of life and to
world peace.
IV. The people have the right and the duty to participate individually and collectively in
the planning and implementation of their health care.
V. Government Responsibility:
Government has a responsibility for the health of their people which can be fulfilled only
by the provision of adequate health and social measures. Main social target of
government, international organization and the whole world community in the coming
decades should be the attainment by all peoples of the world by the year 2000 of a level
of health that will permit them to lead a socially and economically productive life.
Primary health care is the key to attaining this target as part of development in the spirit
of social justice.
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V I. P.H.C. Definition

Primary health care is a strategy of essential health care based on practical, scientifically sound
and socially acceptable methods and technology made universally acceptable to individuals and
families in the community through their full participation and at a cost that the community and
country can afford to maintain at every stage of their development in the spirit of self-reliance
and self-determination .It forms an integral part both of the country’s health system, of which it
is the central function and main focus, and of the overall social and economic development of the
community. It is the first level of contact of individuals, the family and community with the
national health system bringing health care as close as possible to where people live and work,
and constitutes the first element of continuing health care process.

VII. Primary Health Care:

1. Reflects and evolves from the economic condition and socio-culture and political
characteristic of the country and its committees and is based on the application of the
relevant results of social, biomedical and health services research and public health
experience.;
2. Addresses the main health problem in the community, providing promotive,
preventive , curative and rehabilitative services accordingly;
3. Includes at least education concerning prevailing health problems and the methods of
preventing and controlling them; promotion of food supply and proper nutrition; an
adequate supply of water and basic sanitation; maternal and child health care,
including family planning; immunization against the major infectious diseases;
prevention and control of locally endemic diseases; appropriate treatment of common
diseases and injuries, and provision of inessential drugs;
4. Involves, in addition to the health sector, all related sectors and aspects of national
and community development, in in particular agriculture, animal husbandry, food,
industry, education, housing, public work, communications and other sectors; and
demands the coordinated efforts of all those sectors;
5. Requires and promote maximum community and individual self-reliance and
participation in the planning, organization, operation and control of primary health
care, making fullest use of local, national and other available resources; and to this
end develops through appropriate education, the ability of communities to participate.
6. Should be sustained by integrated, functional and mutually supportive referral
systems, leading to the progressive improvement of comprehensive health care for all,
and giving priority to those most in need;
7. Relies, at local and referral levels, on health workers, including physicians, nurses,
midwives, auxiliaries and community workers as applicable, as well as traditional
practitioners as needed, suitably rained socially and technically to work as a health
team and to respond to the expressed health needs of the community.
3

VIII.
All governments should formulate national policies, strategies and plans of action to launch and
sustain primary health care as part of a comprehensive national health system and in coordination
with other sectors. To this end, it will be necessary to exercise political will, to mobilize the
country=s resources and to use available external resources rationally.

IX.

All country should in a spirit of partnership and service to ensure primary health care for all
people since the attainment of health by people in any one country directly concern and benefits
every other country. In this context the joint WHO/UNICEF report on primary health care
constitutes a solid basis for the further development and operation of primary health care
throughout the world.

X.

An acceptable levels of health for all the people of the world by the year 2000 can be attained
through a fuller and better use of the world=s resources, a considerable part of which is now
spent on armament and military conflicts. A genuine policy of dependency, peace, détente and
disarmament could and should release additional resources that could well be devoted peacefully
aims and in particular to the acceleration of social and economic developing of which primary
health care, as the essential part, should be allotted its proper share

The international Conference on Primary Health Care calls for urgent and affective national and
international actions to develop and implement primary health care throughout the world and
particularly in developing countries in a spirit of technical cooperation and keeping with New
International Economic Order. It urges governments, WHO and UNICEF, and other international
organizations, as well as multilateral and bilateral agencies, non-governmental organization,
funding agencies, all health workers and the whole world community to support national and
international commitment to primary health care and to channel increased technical and financial
support to it, particularly in developing countries. The Conference calls on all the
aforementioned to collaborate in introducing, developing, and maintaining primary health care in
accordance with the spirit and consent of declaration.
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2.0 The PHC Concept and mechanics

Alma Ata Declaration “health for all by the year 2000”

1978 in Alma Atta, USSR

1987 in Bamako (Mali) Bamako conference (review Africa’s progress made since the Alma Ata
conference)

PHC 1. Essential health care based on practical, scientifically sound and socially acceptance
methods and technology made universally accessible to individuals and families in the
community through full participation and at a cost that the community and country can afford to
maintain at every stage of their development in the spirit of self-reliance and self-development.

2. it makes basic health and medical services available, affordable, accessible, acceptable and
applicable to the community with their full participation at all levels to enable each family to live
an economically and socially productive life through self-reliance.

New goal of WHO (Health for all in the 21st century) from the Bamako Initiative

The 5 A’s of PHC

1. Available
2. Affordable
3. Accessible
4. Acceptable
5. Applicable (people should be able to use available services)

PHC is intended to break the visual cycle of dependency which makes the community to feel that
they cannot do without outside support

Bamako Initiative was aimed at reviewing Africa’s progress made some years after Alma Ata. It
addressed:

1. MCH
2. Nutrition
3. Water and Sanitation
4. Essential drugs
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Bamako Initiative targeted:

1. Women
2. Children
3. Elderly people

The types of PHC are

1. Comprehensive PHC
2. Selective PHC

Rationale (Reason why) of PHC

1. 80 -90 percent of diseases in community affects the vulnerable (women, children and
elderly)
2. 80 – 90 percent of diseases in community are preventable
3. There was gross inequality in the health status of people (in both developed and
developing countries).
4. There was a need for equitable (most needed gets more) distribution of health resources.
5. They also listened to stories from other countries where because of Education improved
roads, good food, safe drinking water, disease started to disappear.
6. There was lack of community involvement.

The Objectives of PHC

1. To make basic health and medical services universally available.

2. To promote and protect the health of the people as a way towards social-economic
development.
3. To involve the community at every level in the process of providing basic health and
medical services
4. To break the chain of dependency that holds people down in the pit of (ignorant, disease
& poverty)
5. To help families live socially and economically productive life. (Encourage them that
they are important and can provide for themselves)
6. To distribute health resources equitably (the most needed gets more)
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The mechanics of Primary Health Care

Four (4) Elements of PHC

1. Activities of PHC
2. Philosophy of PHC
3. Strategies of PHC
4. Levels of PHC

The Eight (8) General Activities of PHC

1. Education covering the prevailing health problem and their method of prevention and
control (Health Education)
2. Promotion of nutrition (provision of adequate food and proper nutrition)
3. Provision of adequate supply of safe drinking water
4. Provision of basic sanitation
5. Maternal and child health (including family planning) now called reproductive health
(safe motherhood)
6. Immunization against the major infectious diseases.
7. Prevention and control of endemic diseases (malaria/A.R.I,/Diarrhea)
8. Appropriate treatment for common diseases and injuries

The 9 Additional Activities in Post war and Post Disaster Counties:

1. A referral system
2. Counseling services – used to deal with the aftermath of the civil war.
3. Health Information system (HIS)
4. Health System management (for the management of limited health resources)
5. Physical disability (rehabilitation of those with disability)
6. Micro-economy
7. Orphan care
8. Mental Health (rehabilitation of the mentally ill)
9. Essential Drug supplies
7

Philosophy:

1. Health is so important that it should not be left only with health workers. The community
should be involved
2. Health is an integrated part of social-economic development of an individual family and
society or community as a whole
3. Health service provision required community involvement
4. Health is directly related availability and distribution of resources.

Strategies:

1. Introduce change in the health system to meet the essential needs and achieve maximum
coverage.
2. There is a need for intersectorial coordination
3. There is a need appropriate individual and collective involvement in health.
4. Inform people of their potential, strength and power to acquire better health.

Specific Strategies

1. Establishment of receptive framework (putting into place those ideas that would be
accepted-discussion or meeting) (chief, elders, zoes) everybody.
2. Need community involvement at all levels.
3. Bottom-up decision making approach (the common people or community should make
the decision)
4. De-centralization of planning and implementation of your program.
5. Integration of services (MCH, EPI, FP)
6. Intersectorial collaboration/cooperation and coordination.
7. Re-definition of health workers and health institution’s role
8. Appropriate training and supportive integrated supervision
9. The used of local structures (political, zoes, football teams)

Levels: Seven (7) Levels of PHC Implementation

1. Individual
2. Family
3. Community
4. Facility (clinic) district)
5. Health center (county)
6. County Hospital
7. National referral hospital
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Some principles of PHC

1. PHC operates as a team and the community member are the most important members.
They are the pillows. The health worker is the team leader. And the team leader should
be.
T.E.A.M.
T=Trained and be able to train others
E= energetic, encourage or enable (enabling)
A= active, alert or appreciative
M= manageable and be able to manage

2. Set objectives (clear) S. M. A. R. T.

S= simple
M= Measurable (define, demonstrate, list. Identify) not known
A= Attainable
R= Realistic
T= Time related

3. The three Fs principle:

F1= Facts (technical facts) things that influence decision
F2= feeling (feeling of those to be affected by the decision)
F3= Forces (external forces) have influence

4. The seven (7) Ps Principle

P4= power that be (politicians)
P5= Policies
P6= Priorities
P7= Professionals
P3= Possibility
P2= Problems
P1= People
5. Accommodation Principle (Leaving your own objective and giving way for all achieve on
common goal. These must be accommodative for all to achieve one goal (eg) the 6 man
Tradition Government in Liberia

6. The six (6) Ws Principle:

- Who - When - Why
- What - Where - How
9

Some mis-conception about PHC

1. People though PHC was a separate health program but rather it is only a strategy within
the existing health program.
2. People think PHC is a cheap program or strategy by actually it is not cheap.
3. People thought that PHC was a alternative to curative medicine
4. Some people think PHC is Non-scientific
5. Some people think that PHC is only for the poor. This is false. It is for everybody at all
levels.
6. Some people say PHC is simple
7. Mr. knows all syndromes (Expert). There is no expert in PHC
8. People think PHC is shifting cost

The role of the community Health Worker

1. Community Mobilizer
2. Health Educator
3. Health Service Provider
4. Animator/Facilitator
5. Change Agent (Agent of Change)

Support Structures

1. Community (provision of incentive/goods)

2. CDC (Community Development Committee)
3. Immediate Health Team (training & supervision) CHC
4. County Health Team (training, supplies & supervision)
5. Sectorial Agencies (logging companies)
6. National level (training institution, research institution)
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3.1 COMMUNITY BASED HEALTH CARE

OBJECTIVE

1. Define Community
2. Discuss community diagnosis
3. Define community involvement and list its benefits
4. List and discuss community resources
5. Discuss social mobilization
6. State the importance of CBHC
7. Explain how to start community based health care (CBHC)

CBHC are those basic health and medical services given to the community by people in the
community with or without external support.

Importance of CBHC in post war Liberia

- Health problems are understood and health workers know their roles
- Community involvement bring about community acceptance of health care and
ownership
- Because of limited resources (Poverty)
1) Community Diagnosis: identifying the nature, strength, potential, weakness and
problems of the community and identifying their underlying causes and exploring for
possible solutions.
2) CHW is a community is a community member chosen by the community, trained in the
community, serving the community as a health educator, health provider and agent of
change who may be paid by the community but is a property of the community and not
the NGOs or government.

Criteria for CHW selection

1. Should be well respected and friendly
2. Concerned about the welfare of others
3. Confidential person (avoid gossip)
4. Not be interested in status or money
5. Be a good parent (setting good examples)
6. Willing to visit any community member
7. Intelligent and willing to learn
8. Have interest in job
9. Be in good health and age
10. Have moral support of his or her family
11. Maybe already engaged in health work (TBA, healer)
12. Maybe male or female depending on nature of work
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13. Education in English or an added advantage

14. Resident of the community

Community is a group of people living together with a common goals or interest (realistic view)

A) it is geographic area when people live together and share common view (simplistic view)
B) group of people with common interest whether living in the same geographical location
or not (practical view)
TYPES OF COMMUNITIES

1. Homogeneous community-community with the same ethnic group

2. Heterogeneous community – is a mixed ethnic groups
Things to look for when doing community diagnosis

1. Population
2. Facilitation factors
3. Housing
4. Social services
5. Environment (location)
6. Inhibitory factors
7. Types of community (small or big)
8. Leadership
9. Strength
10. Social structure
11. Weakness
12. Gen. Health status
13. Facilitating factors
14. Maternal health status

Community social mobilization – is bring the community together to creat awareness on a

particular issue using a social means to motivate the community(using the cultural troop)

- Is a process of providing information that will stimulate the community

- Preparing the community to get involved in what they are to do.
THINGS YOU WANT TO DO BEFORE

a) Know you objective

b) Know what to say
c) Know how to say it
d) Be practical and realistic
e) Be cordial, friendly and accommodating.
1. Visit community at least 3 time (are week internal)
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2. Talk about – setting up CHC

- Role of CHC
- Selection of CHC members
- Training of CHW
- Compensation of CHC
- Your role in health program
- What is expected of the community?
- If you from an organization, what is that organization’s role
- Caution – No political statements
No empty promises
No raising expectations too high
No inducements
Be frank, friendly, firmed
Be respectful
Respect views, value & traditions of the people

Which community to start with?

Use the able will matrix:

1. Willing and able
2. Willing and not able
3. Not willing and able
4. Not willing and not able
COMMUNITY RESOURCES – can every community participate in PHC?

1. Tangible resources – concrete resources (you can feel and touch) (man power, car,
money, cattle, water)
2. Intangible resources (Abstract) time, talent, wisdom, potential, influence, will power,
knowledge, ambition, rules, culture and tradition, unity, supportive, structure.
Community Involvement and it Benefits
Community involvement – the process by which community take part in decision making and
management of health matters in community.

Benefits: (1) ownership (proper maintenance) established

(2) Acceptability
(3) Active and full community participation
(4) Sustainability
(5) Help them to better prioritize objectives and make use of them.
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4.1 COMMUNITY DIAGNOSED AND SURVEY

OBJECTIVE

1. Know conceptual frame work and definition of HIS

2. Know and be able to discuss the major characteristics of HIS
3. Know how to design a simple PHC, HIS
4. List and discuss the types of survey
5. State why the community survey is necessary
6. Discuss when survey should done
7. List and discuss material needed to do survey
8. Discuss demonstration of data getting
9. Discuss how to gather and analyze data
10. Know and be able to discuss monitoring evaluation of HIS
354 health facilities in Liberia

5 departments of MOH

HIS is a mechanism that you put in place to collect health status measurement data, store the
data, make the retrievable, conduct analysis, interpret findings and provide feedback.

HIS Mechanism (functions)

Collect Store Retrievable Analyze Data Interpret Data Feedback

Data Data

NOTE:

 In HIS data collected comes from services rendered. (family planning, curative and
preventive)
 The PHC/HIS should be structured by the community health department. The community
health department should have the eight (8) components

Major characters of HIS:

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INPUT (financial input)

PROCESS (management)
OUTPUT (feedback on patient care)

HIS generates Health status measurement data

1. Collect
2. Store
3. Retrieve
4. Analysis
5. Feedback
Design of simple PHC/HIS

 The design should follow the eight PHC components of activities

You should be able to get data on;
1) Mortality (data)
2) Morbidity (discuss)
3) Disability
4) Utilization of health care services
- EPI,MCH/FP
5) Social welfare
- Orphans care
COMMUNITY DIAGNOSIS (COMMUNITY MEDICINE)

Community – is an organized and well-structured or demarcated area where a group of people

lives together. Some properties of community are:

- Definite population
- Social service
Catchments population is the part of the community that has easy access to available services

Diagnosis: finding out health and social problems found in the community.

In clinical medicine – you deal with one person. The person comes to you.
In community medicine – you deal with a group of people or the community.
In this you must go to the community.
In the structure of a community’s health, there are:
1. Tradition health system
2. Western health system
3. The community health care system
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What does Community diagnosis finds out? :

1. What is the health status of the community?
2. What are the factors responsible for the health status?
3. What has been done by the community about this health status?
4. What can be done about this health status?
The health status of the community:
1. Is this a healthy community? – What are the health problems?
Factors responsible for health status:
1. Direct factor utilization of health service (immunization, environment)
2. Indirect factors – Social (marriage, education, sex, age, occupation) economic, culture
The community carried out some health interventions relating to the existing health
problem.
What can be done about this health status?
- Set up comprehensive intervention (active and routine surveillance
- Community involvement/ participation (social mobilization)
- Standard case definition for the health event/diseases
- Confirmation
- Give them feedback (reports)
*Epidemic disease – keep active surveillance
*Non-epidemic diseases – keep a routine surveillance
How do we conduct community Diagnosis?
1. Though surveys

Types of survey
1. Comprehensive survey (census)
2. Sample survey (few)
3. Longitudinal Survey
4. Pilot survey
5. Focus group discussion (discussants must be homogeneous)
6. Simple structured questionnaire ( Self-interviews)
7. Cross-sectional survey ( Half of the community is targeted)
8. KAP (Survey the Knowledge, Attitudes & Practices of the people)
9. Baseline survey
10. Descriptive survey
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Reason why surveys are necessary:

1. To collect baseline information on the health status of the population

2. Evaluation
- Baseline indicators (indicator)
- Post baseline (intervention/indicator)
When should surveys be done?

I. Surveys should be done before establishing by health system/progress. How should

survey be done through the: (all of the types of surveys are summarized in these 2)
1. Review of secondary source data baseline information (indicator)
2. Primary data collection activity
Planning and conducting survey
Epidemiological survey use various study designs and range widely in size. At one extreme a
case-control investigation may include fewer than 50 subjects, while at the other, some large
longitudinal studies follow up many thousands of people for several decades. The main study
designs will be described in later chapters, but we here discuss important features that are
common to the planning and execution of surveys, whatever their specific design.

Early planning

The success of data collection requires careful preparation. The first and often the most difficult
question is why am I doing this survey?” many studies start with a general hope that something
interesting will emerge, and they often end in frustration. The general interest has first to be
translated into precisely formulated, written objectives. Every survey should be reasonably sure
to give an adequate answer to at least one specific question. This initial planning requires some
idea of the final analysis; and it may be useful at the outset to outline the key table for the final
report, and to consider the numbers of cases expected in their major cells. Every study needs a
primary purpose. It is easy to argue “While we have the subjects there, let’s also measure…”; but
overloading, whether of investigators or subjects, must be avoided if it in any way threatens the
primary purpose. Sometimes subsidiary objectives may be pursued in subsamples(every nth
subject, or in a particular age group) or by recalling some subjects for a second examination:
when their initial contact has been favorable then response to recall is usually good

Background reading

Before planning the detail of a study, it is wise to carry out a library search of the relevant
background publications. Occasionally this may show the answer to the study question without
any need for further data collection; or it may uncover useful sources of published information,
such as the registrar general’s mortality and cancer registry reports, which can form the basis of
an analysis without the requirement for an expensive and time consuming field survey. Even
17

when survey work remains necessary, experience in earlier related investigations may guide the
design or indicate pitfalls to be avoided.

Choice of examination methods

The overriding need in an epidemiological survey is to examine a representative sample of
adequate size in a standardized and sufficiently valid way. This determines the choice of
examination methods and the points where these differ from those of clinical practice. Methods
must be acceptable, and if possible noninvasive, or else cooperation suffers and the study group
becomes unrepresentative they must be relatively cheap and quick, or not enough subjects can be
examined: with fixed resources the need for detail conflicts with the need for members. Most
important of all, methods and observers must be capable of rigorous standardization; even if this
excludes the benefits of clinical judgment.

Information abstracted from existing records

Sometime adequate standardize information is already available from existing records. For
example, in a study to examine the long term incidence of hypothyroidism after treatment with
radioiodine for thyrotoxicosis, it was possible to identify treated patients and obtain the
information needed to follow them up (name, date of birth, sex, address etc.) by searching
hospital files. When existing records are exploited in this way, the required information is
normally abstracted on to a specially designed form or even direct on to a portable computer.

The design of the abstraction form or of the computer program for inputting data should take into
account the layout of the source material. Having to flick repeatedly backwards and forwards
through the source record is not only tedious and time consuming, but may also increase the
chance of error. Each abstracted record should be identified by a serial number, and should
include sufficient information to permit easy access back to the source material for checking and
to obt2in additional data if required. When data are not abstracted direct on to computer, later
transfer to computer will often be facilitated by numerical coding, in which case coding boxes
can be provided on the right hand side of the abstraction form. Some items of data (for example,
dates of birth) can easily be written direct into the coding boxes. Others, such as occupation, may
need to be recorded in words and coded later as a separate exercise. Time spent writing is
minimized if non-numerical information is, when possible, ringed or ticked rather than having to
be written out. To minimize the chance of error, any reformulation of numerical data (for
example, derivation of age at hospital admission from date of birth and date of admission) should
be carried out by the computer after date entry, and not as part of the abstraction process. When
coding data, allowance must be made for the possibility of missing information.

Questionnaires
Epidemiological data are often obtained by means of questionnaires. These may be either self
administered (that is, completed by the subject) or administered at interview. Self administered
questionnaires are easier to standardize because the possibility of systematic differences in
interviewing technique is avoided. On the other hand, they are limited by the need to be
18

unambiguously understood by all subjects. An interviewer may be essential to collect

information on complex topics.

Good design of questionnaires requires skill. The language used should be clear and simple. Two
short questions, each covering one point, are better than one longer question which covers two
points at once. A question that has been used successfully in a previous study has obvious
advantages. The order of questions should take into account sensitivities of the person to whom
they are addressed –it is better to start with “What is your date of birth?” than launch straight into
“Have you ever been treated for gonorrhea?” and should be designed to facilitate recall. For
example, all questions relating to one phase of the person’s life might be grouped together. As a
check on the reliability of information, it may sometimes be helpful to include overlapping
questions. In a study of risk factors for back pain, some people reported that their jobs entailed
driving for more than four hours a day but did not involve more than two hours sitting. This
suggests that they had not properly understood the questions. An important consideration is
whether to use closed or open ended questions. Closed ended questions, with one box for each
possible answer (including “don’t know”) are more readily answered and classified, but cannot
always collect information in he detail that is required. When interviewers are used then the
wording with which they ask questions should be standardized as far as is compatible with the
need to obtain useful information. As in abstracting existing records, the forms used to record
answers to questions should be designed for ease and accuracy of completion and to simplify
subsequent coding and analysis.

Physical examination and clinical investigations

Methods of physical examination should be designed to reduce variation within and between
observers. Often, a quantitative measurement (for example, respiratory rate) is easier to
standardize than a qualitative judgement (whether someone is techypnoeic or not).

Standardization of Laboratory assays can be improved by careful specification of the method by

which specimens should be collected and by rigorous quality control of the analysis

Whatever method of data collection is adopted, it is usually worth trying it out in a pilot survey
before embarking on the main study. Identification of practical snags at this stage can save much
difficulty later. In large studies the questionnaire or record design should be discussed with the
statistician who will later be concerned in the analysis.

Staff and training

In a small study the doctor himself may do all the work, but in large surveys he will need
helpers. If an epidemiological examination technique requires skill and clinical judgement it has
probably been insufficiently standardized: if it is adequately standardized it can usually be taught
to any intelligent person.

The figure shows how two observers had distinct but opposite time trends in their performances
during the early stages of a survey of skinflod thickness. Such training effects, which are
19

common, should have been completed before the start of the main study: new staff needs
supervised practice under realistic filed conditions followed by pre-survey testing.

Trend in mean values for triceps skinfold thickness obtained by two observers in the same survey

Despite all precaution, observer differences may persist. Observers should therefore be allocated
to subjects in a more or less random way: if, for example, one person examined most of the men,
and another most of the women, then observer differences would be confounded with true sex
differences. To maintain quality control throughout the survey each examiner’s identity should
be entered on the record, and results for different examiners may then be compared.

Sampling
Sample size
Most surveys and trials are smaller than the investigator would wish, lack of numbers often
setting a limit to some desirable subgroup analysis. This is inevitable. What can be avoided is
discovering only at the final analysis that numbers do not permit achievement even of the study’s
primary objective. To prevent this disappointment the purpose of the study has first to be
formulated in precise statistical terms. If the aim is to estimate prevalence, then sample size will
depend on the required accuracy of that estimate. (Table 5.1 gives some examples). Sampling
error is proportionally greater for less common conditions; that is to say, to achieve the same
level of confidence requires a larger sample if prevalence is low.

Table 5.95% confidence limits for various rates and sample size

95% confidence limits

Estimated prevalence (%)
n=500 n=1000
1.2-3.1
2 1.0-3.7
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8.2-12.0
10 7.5-13.0
17.6-22.6
20 16.6-23.8

Techniques also exist for calculating sample sizes required for estimating, with specified
precision, the mean value of a variable, or for identifying a given difference in prevalence or
mean values between two populations. These techniques may be found in textbooks or (better)
by consulting a statistician; but either way the investigators must first know exactly what they
want to achieve.

Sampling methods
When the study sample is selected from a larger study population, statistical inference will be
more rigorous if the selection process is random, or effectively random; that is to say, if each
individual in the study population has a know(usually identical) non-zero probability of
selection. To achieve this a census or listing of the study population is first required. In a survey
of adults in a hospital district the electoral register will probably serve. In an occupational group
the payroll is invariably complete, and in a school there are class registers. In general practice
there is an age-sex register. To choose a simple random sample the listed people are numbered
serially. Numbers within the appropriate range are then read off from a table or computer
generated list of random numbers until enough people have been selected.

It may be that an investigator wishes to choose a sample in which certain subgroups (particular
ages, for instance, or high risk categories) are relatively overrepresented. To achieve his he may
divide the study population into subgroups (strata) and then draw a separate random sample from
each, while adjusting the various sample sizes to suit the investigation’s requirements. This is a
stratified random sample.

The study population may be large and widely scattered-for example, all the general practices in
a city- but for the sake of convenience the investigator may wish to concentrate his survey in a
few areas only. This can be done by drawing first a random sample of practices, and then, within
these practices, drawing a random sample of individuals. Such two stage sampling works well,
but there is some loss of statistical efficiency, especially if only a few units are selected at the
first stage.

Recruiting subjects
Most people are willing to take part in medical surveys provided that they trust the investigators,
just as patients will nearly always help their own doctors in their research. In population studies,
however, there has usually been no previous contact. The selected subjects’ need an explanation
of the purpose of the study, of why they in particular have been asked to take part, of what is
expected from them, and what if anything they will get out of it (for instance a medical checkup
or a report on the research findings). Local general practitioners, too, need to know what is going
on. Time given to preparatory public relations is always well spent.
21

Response must be made as easy as possible. If attendance at a centre is required, it is better to

send everyone a provisional appointment than to expect them to reply to a letter asking whether
they are willing to attend. Provision of transport may be welcomed. Often the difference between
a mediocre response and a good one is tactful persistence, including second invitations (perhaps
by recorded delivery), telephone calls, identifying the reasons for non-attendance, and home
visits.

Response rates
The level of response that is acceptable depends both on the study question and on the population
in which the question is being asked. Problems arise because non-responders may be atypical.
For example, in a survey of coronary risk factors among adults registered with a group practice,
those at highest risk may be the least inclined to complete a questionnaire or attend for
examination. If a response rate of 85% were achieved, an estimated prevalence of heavy alcohol
consumption of 3% among the responders could be substantially too low if most of the
nonresidents drank heavily. On the other hand an estimated 50% prevalence of smokers would
not need major revision, even if all of the non-responders smoked.

What matters is how unrepresentative non-responders are in relation to the study question. It is
not important whether they are atypical in other respects. In a survey to evaluate the association
between serum IgE concentrations and ventilator function it would not matter if non-responders
had an unusually high frequency of respiratory disease, provided that the relation of their
ventilator function to IgE was not unrepresentative.

Assessment of the likely bias resulting from incomplete response is ultimately a matter of
judegement. However, two approaches may help the assessment. Firstly, a small random sample
can be drawn from the non-responders, and particularly vigorous efforts made to encourage their
participation, including home visits. The finding for this subsample will then indicate the extent
of bias among non-responders as a whole. Secondly, some information is generally available for
all people listed in the study population. Form this it will be possible to contrast responders and
non-responders with respect to characteristics such as age, sex, and residence. Differences will
alert the investigator to the possibility of bias.

In addition, it may help to put absolute bounds on the uncertainty arising from non-response by
making extreme assumptions about the non-responders. For example, if the aim of a survey were
to estimate a disease prevalence, what would be the prevalence if all of the non-responders had
the disease, or none of them?

Data Analysis
Small studies can sometimes be analyzed manually with the help of a calculator.
Nowadays, however, the analysis of epidemiological data is almost always carried out by
computer. With recent advances in technology, all but the largest data sets can be handled
22

satisfactorily on a personal computer. Moreover, a wide range of software packages is now

available to assist epidemiological analysis.

The starting point for analysis by computer is the coding and entry of data. These procedures
should be checked, usually by carrying them out in duplicate. In addition, once the data have
been entered, further checks should be made to ensure that all codes are valid (for example,
nobody should have 31 February as a birth date) and to look for any internal inconsistencies
(such as a date of admission to hospital being earlier than the subject’s date of birth). Statistical
analysis should only begin when the data set is as “clean” as possible.

With the ready availability of software packages, it is tempting for medical investigators to
embark on analyses they do not fully understand, and in the process they may use inappropriate
statistical techniques. For this reason it is preferable to obtain advice from a statistician when
carrying out all but the simplest analyses. As with the earlier stages of data processing, statistical
calculations should all be checked.

Data Gathering is done by:

Developing questionnaire based on:

1. Demographics of community
2. Population structure and distribution
3. Problem
4. Immunization
 Full coverage
 Partial coverage
 No coverage

5. Sanitation (water and sanitation)

- Access to safe sources of H20
- Access to safe sources of excreta disposal
- Access to safe source of garbage disposal

Types of H20 sources:

1. Pipe born H20
2. Hand pump
3. Protected dug well
4. Creek / stream
5. Open dug well

Time taken to access H20

23

This means checking the times taken to access all of the H20 sources and find the average time
taken to reach then. This should be expressed on the form / questionnaire.

Evaluation is an important component for the PHC.

Evaluation measure: you need your indicators or targets
1. Measure progress (achievement)
2. Measure impact

In interpreting evaluation results you must talk about:

1. Weakness (constrains)
2. Successes
3. Challenges (threats to health care system)
4. Opportunities

S. W. O. T. analysis on an intervention

S = success O = opportunities
W = weakness T = threats

Data interpretation:

Data interpretation is done through a process using statistics (% rates)

1. Numerator (average affected population)
2. Denominator (total population)

Some types of rates:

a. Incidence rate (New cases) b. prevalence rate (New + Old cases)

Indicators is a comparison of the initial state (baseline measurement) against the existing or
actual.

Types of indicators:
1. Baseline indicator
2. Process indicator
3. Outcome indicator

Example: # of trainings conducted

# of health workers trained
% of health workers trained
% of training materials in place
24

Graphs (charts) are charts indicating the frequency of occurrence.

Type of graph
1. Line graph
2. Bar graph
3. Pie chart
25

5.1 The Millennium Development Goals

Background

In 2001, recognizing the need to assist impoverished nations more aggressively, UN member
states adopted the targets. The MDGs aim to spur development by improving social and
economic conditions in the world’s poorest countries.

They derive from earlier international development target, and were officially established at the
Millennium Summit in 2000, where all world leaders present adopted the United Nation
Millennium Declaration, from which the eight goals were promoted.

Goals

The percentage of the world’s population living in extreme poverty has halved since 1981. The
graph shows estimates and from the World Bank 1981 – 2000. Most of the improvement has
occurred in East and South Asia

The Millennium Development Goals (MGDs) were developed out of the eight chapter of the
United Nation Millennium Declaration, signed in September 2000. There are eight goals with 21
targets, and a series of measurable indicators for each target

Goal 1: Eradicate Extreme poverty and hunger

 Target 1A: Halve the proportion of people living on less than $1 a day
o proportion of population below $1 per day (PPP values0
o poverty gap ration [incidence x depth of poverty]
o share of poorest quintile in national consumption
 target 1B: Achieve Employment for women, men and young people
o GDP Growth per employed person
o Employment rate
o Proportion of employed population below $1 per day (PPP values)
o Proportion of family-based workers in employed population
 Target 1C: Halve the proportion of people who suffer from hunger
o Prevalence of underweight children under five years of age
o Proportion of population below minimum level of dietary energy consumption
26

Goal 2: Achieve universal Primary

 Enrollment in primary education

 Completion of primary education
 Literacy of 15 – 24 year olds, female and male
Goal 3: Promote gender equality and empower women

 Target 3 A: Eliminate gender disparity in primary and secondary education

preferably by 2005, and at all levels by 2015
o Ratios of girls to boys in primary, secondary and tertiary education
o Share of women in wage employment in the non-agricultural sector
o Proportion of seats held by women in national parliament

Goal 4: Reduce Child Mortality

 Target 4A: reduce by three quarters, between 1990 and 2015, the under-five
mortality rate
o Under-five mortality rate
o Infant (under 1) mortality rate
o Proportion of 1-year-old children immunized against measles

Goal 5: Improve Maternal Health

 Target 5A: reduce by three quarters, between 1990 and 2015, the maternal
mortality ratio
o Maternal mortality ratio
o Proportion of births attended by skilled health personnel
 Target 5A: achieve, by 2015, universal access to reproductive health
o Contraceptive mortality ratio
o Adolescent birth rate
o Antenatal care coverage (at least one visit and at least four visits)
o Unmet need for family planning

Goal 6: Combat HIV/AIDS, malaria and other diseases

 Target 6A: Have halted by 2015 and begun to reverse the spread of HIV/AIDS
o HIV prevalence among population aged 15 – 24 years with comprehensive
correct knowledge of HIV/AIDS
o Condom use at last high-risk sex
o Proportion of population aged 15 – 24 years with comprehensive correct
knowledge of HIV/AIDS
27

o Ratio of school attendance of orphans to school attendance of no-orphans aged

10 – 14 years
 Target 6B: Achieve, by 2010, universal access to treatment for HIV/AIDS for all
those who need it
o Proportion of population with advanced HIV infection with access to
antiretroviral drugs

 Target 6C have halted by 2015 and begun to reverse the incidence of malaria and
other major diseases
o Prevalence and death rates associated with malaria
o Proportion of children under 5 sleeping under insecticide-treated bednets
o Proportion of children under 5 with fever who are treated with appropriate anti-
malaria drugs
o Prevalence and death rates associated with tuberculosis
o Proportion of tuberculosis cases detected and cured under DOTS (Directly
Observed Treatment Short course)

Goal 7: Ensure environmental sustainability

 Target 7A: Integrate the principles of sustainable development into country policies
and programmes; reverse loss of environmental resources
 Target 7B: Reduce biodiversity loss, achieving, by 2010, a significant reduction in
the rate of loss
o Proportion of land area covered by forest
o CO2 emissions, total, per capita and per 1 GDP (PPP)
o Consumption of Ozone-depleting substances
o Proportion of fish stocks within safe biological limits
o Proportion of total water resources used
o Proportion of terrestrial and marine area protected
o Proportion of species threatened with extinction
 Target 7C: Halve, by 2015, the proportion of people without sustainable access to
safe drinking water and basic sanitation (for more information see the entry on
water supply)
o Proportion of population with sustainable access to improved water source,
urban and rural
o Proportion of urban population with access to improved sanitation
 Target 7D: by 2020, to have achieved a significant improvement in the lives of at
least 100 million slum-dwellers
28

o Proportion of urban proportion living in slums

Goal 8: Develop a global partnership for development

 Target 8A: develop further an open, rule-based, predictable, nondiscriminatory

trading and financial system
o Includes a commitment to good governance, development and poverty reduction-
both nationally and internationally
 Target 8B: Address the special Needs of the Least Developed Countries (LDC)
o Includes: tariff and quota free access for LDC exports; enhanced programme of
debt relief for HIPC and cancellation of official bilateral debt; and more
generous ODA (Overseas Development Assistance) for countries committed to
poverty reduction
 Target 8C: Address the special needs of landlocked developing countries and small
island developing states
o Through the programme of Action for the Sustainable Development of Small
Island Developing States and the outcome of the twenty-second special session of
the General Assembly
 Target 8D: Deal comprehensively with the debt problems of developing countries
through national and international measures in order to make debt sustainable in
the long term

Indicators

Some of the indicators listed below are monitored separately for the least developed countries
(LDCs) Africa, landlocked developing countries and small island developing states.

 Official development assistance (ODA)

o Net ODA, total and to LDCs, as percentage of OECD/DAC donors’ GNI
o Proportion of total bilateral, sector-allocated ODC of OECD/DAC donors to basic
social services (basic education, primary health care, nutrition, safe water and
sanitation)
o Proportion of bilateral ODA of OECD/DAC donors that is untied
o ODA received in landlocked countries as proportion of their GNIs
o ODA received in small island developing states as proportion of their GNIs
 Market access
o Proportion of total developed country imports (by value and excluding arms) from
developing countries and from LDCs, admitted free of duty
o Average tariffs imposed by developed countries on agricultural products and
textiles and clothing from developing countries
o Agricultural support estimate for OECD countries as percentage of their GDP
29

o Proportion ODA provided to help build trade capacity

 Debt sustainability
o Total number of countries that have reached their HIPC decision points and
number that have reached the HIPC completion points (cumulative)
o Debt relief committed under HIPC initiative, US$
o Debt service as a percentage of exports of goods and services
 Target 8E: In co-operation with pharmaceutical companies, provide access to
affordable , essential drugs in developing countries
o Proportion of population with access to affordable essential drugs on a sustainable
basis
 Target 8F: in co-operation with the private sector, make available the benefits of
new technologies, especially information and communications
o Telephone lines and cellular subscriber per 100 population
o Personal computers in use per 100 population
o Internet user per 100 population

Progress

Progress towards reaching the goals has been uneven. Some countries have achieved many of the
goals, while others are not on track to realize any. The major countries that have been achieving
their goals include China (whose poverty population has reduced from 452 million to 278
million) and India due to clear internal and external factors of population and economic
development. However, areas needing the most reduction, such as the Sub-Saharan Africa
regions have yet to make any drastic changes in improving their quality of life. In the same time
as China, the Sub-Saharan Africa reduced their poverty about one percent and are at a major risk
of not meeting the MDGs by 2015. Fundamental issues will determine whether or not the MDGs
are achieved, namely gender, the divide between the humanitarian and development agendas and
economic growth, according to the Overseas Development Institute.

To accelerate progress towards the MDGs, the G-8 Finance Minister met in London in June 2005
( in preparation for the G-8 Gleneagles Summit in July) and reached an agreement to provide
enough funds to the World Bank, the IMF, and the African Development Bank (ADB) to cancel
an additional $40 – 55 billion debt owed by members of the HIPC. This would allow
impoverished countries to re-channel the resources saved from the from the forgiven debt to
social programs for improving health and education and for alleviating poverty

Backed by G-8 funding, the World Bank, the IMF, and the ADB each endorsed the Gleneagles
plan and implemented the Multilateral Debt Relief Initiative (“MDRI”) to effectuate the debt
30

cancellation. The MDRI supplements HIPC by providing each country that reached the HIPC
completion point 100% forgiveness of its multilateral debt forgiveness once their lending agency
confirmed that the countries had continued to maintain the reforms implemented during HIPC
status. Other countries that subsequently each the completion point automatically receive full
forgiveness of their multilateral debt under MDRI.

While the World Bank and ADB limit MDRI to countries that complete the HIPC program, the
IMF’s MDRI eligibility criteria are slightly less restrictive so as to comply with the IMF’s
unique “uniform treatment” requirement. Instead of limiting eligibility to HIPC countries, any
country with annual per capita income of $380 or less qualities for MDRI debt cancellation, the
IMF adopted the $380 threshold because it closely approximates the countries eligible for HIPC.

Yet, as we head towards 2015 increasing global uncertainties, such as the economic crisis and
climate change, have led to an opportunity to rethink the MDG approach to development policy.
According to the ‘In Focus’ policy Brief from the Institute of Development Studies, the ‘After
2015’ debate is about questioning the value of an MDG-type, target-based approach to
international development, about looking to an uncertain future and exploring what kind of
system is needed after the MDG deadline has passed.

Controversy over Funding of 0.7% of GNP

Over the past 35 years, the members of the UN have repeatedly made a “commitment that 0.7%
of rich-countries’ gross national product (GNP) to Official Development Assistance.” The
commitment was first made in 1970 by the UN General Assembly.

The text of the commitment was:

“Each economically advanced country will progressively increase its official development
assistance to the Developing Countries and will exert its best efforts to reach a minimum net
amount of 0.7% of its gross national product at market prices by the middle of the decade.

However, there has been disagreement from the US, and other nations, over the Monterrey
Consensus that urged “developed countries that have not done so to make concrete efforts
towards the target of 0.7% of gross national product (GNP) as ODA to developing countries.

Support for the 0.7% Target

The UN “believe(s) that donors should commit to reaching the long-standing target of 0.7% of
GNP by 2015.

The European Union has recently reaffirmed its commitment to the 0.7% aid targets. The EU
External Relations council says that, as of May 2005, “four out of the five countries, which
exceed the UN target for ODA of 0.7% of GNI, are member states of European Union.”
31

Many organizations are working to bring US political attention to the Millennium Development
Goals. in 2007, The Borgen Project worked with Sen. Barrack Obama on the Global Poverty
Act, a bill requiring the White House to develop a Strategy for achieving the goals. As of 2009,
the bill has not passed, but Barrack Obama has since been elected President.

Challenges to the 0.7% Target

However, many OECD nations, including key members such as the United States, are not
progressing towards their promise of giving 0.7% of their GNP towards poverty reduction by
target year of 2013. Some nations’ contributions have been criticized as falling far short of 0.7%

John Bolton argues that the US never agreed in Monterrey to spending 0.7% of GDP on
development assistance. Indeed, Washington has consistently opposed setting specific foreign-
aid target since the UN general Assembly first endorsed the 0.7% goal in 1970.

The Australian Government has committed to providing 0.5% of GNI in International

Development Assistance by 2015 – 2016, without noting the long-standing 0.7% goal.
32

. 6.0 REVOLVING DRUG FUND (DRUG & MEDICAL SUPPLIES)

Objective:
1) Describe the steps of planning R. D. F. scheme
2) Describe the general concept of R. D. F and common pit fall
3) Describe the difference between cost shearing scheme and R. D. F.
4) Be aware of some planning and implementation issues.
5) Describe logistics of drug management
6) Discuss areas of selection procurement, distribution and use
7) Inventory and control.

Revolving Drug Fund: is a financing mechanism put in place for the provision of drugs / medical
supplies in the public sector as well as the private sector.

Crucial issues in setting up R. D. F:

1) Peace Security (stability) 3) Policies ( government)
2) Good/stable economy (currency) 4) Initial capital (Seed stock)

Key steps in setting up R. D. F at any level

1. Sensitization of community on R.D.F by RDF management team
- Meeting of various groups (political leaders, elders & zoes teachers, religious leaders,
youth)
 State problem and reason of introduction R. D.F.
 Explain what R.D.F is and how it works

2. Set up R.D.F committee

3. Set up R.D.F management team
- CHO / P.H.O - C.H.O
- Supervisor (CHD) - C.L.O
- Hospital administrator
Thing that make R.D.F functioned
1. Proper accountability (Transparency)
2. Good Decision making on
 Price
 Storage
 Treasury
 Exemptions (gratis)
 Section / procurement
33

3. Regular and proper supervision

4. Auditing

R. D. F. at Community level

1. Sensitization of community
2. Formation of community health committee (C. H. C.) Health work cannot head C.H. C
because you cannot audit yourself

3. Seed stock collection

4. Storage

5. Selection / purchasing

6. Evaluation

7. Auditing (doing physical count)

Community’s role in setting up R.D.F

1. Providing seed stock

2. Identify head of committee (C.H.C.)
3. Provide storage and security
4. Sustain project
5. Decision making
34

7.0 RATIONAL USE OR DRUGS / APPROPRIATE DRUG USE

WHY IS THE RATIONAL USE OF DURGS NECESSARY?

- Drugs are expensive; therefore to misuse drugs is to throw away money.

- Everybody needs drugs, and the supply of drugs available in our country in limited so
to misuse drugs is to deprive other of needed drugs
- The misuse of drugs could be dangerous t one’s health

HOW DO HEALTH WORKERS MISUSE DRUGS?

 Either they prescribe the wrong drugs because they do not do accurate diagnosis
 Or, they prescribe too many drugs trying to treat the symptoms instead of the disease,
 Or, they give expensive drugs when cheaper ones would work or well,
 Or, they give what the patient wants and not necessarily what is needed
 Or, they allow the drugs to spoil because of wrong packaging ….etc.

HOW CAN PATIENTS MISUSE DRUGS?

 Either they take the wrong medicine,

 Or they take the right medicine but at the wrong time
 Or, they do not complete the dosage, perhaps because they share the medicine with
others or because they feel well only after taking some of the medicine given etc……

PATIENTS MUST THEREFORE BE EDUCATED TO USE DRUGS PROPERLY.

THE FIVE BASIC PLILLARS OF THE CONCEPT OF THE RATIONAL USE OF DRUGS.

1. Accurate diagnosis
2. Rational prescriptions
3. Correct dispersing
4. Suitable packaging
5. Proper use by patient
35

ACCURATE DIAGNOSIS
1. Is the careful examination of a patient and the identification of his or her health problem
so that the appropriate treatment can be given to help cure the patient.

RATIONAL PRESCRIBING
2. Means sensible or reasonable prescribing making a reasonable judgment as to the
strength of medicine, the kind of medicine, the frequency of dosage, and the duration of
treatment based on accurate diagnose and not on what the patient want nor what is
available.

CORRECT DISPENSING
3. Correctly preparing and giving out what has been prescribed

SUITABLE PACKAGING
4. Using the right materials to package the drugs.
Some materials can sometimes cause some drugs to spoil or become ineffective. Eg.
When sugar coated drugs are put in paper package, the drugs ten to get spoiled quickly
when the paper get damp.

PATIENT EDUCATION

Explaining to patients how medicine should be taken

Explain to the patient orally, and also write down the information, since there is usually someone
at the patients home who will do the reading for the patient if he or she cannot read.
36

8.0 STOREROOM MANAGEMENT

A. Storeroom Management is the act of directing and controlling stock movement in a drug
supply system (Health facility, pharmaceutical, ect) stock is a supply of drugs and
medical items kept in a storeroom for the purpose of maintaining and dispensing at the
appropriate time. The drug supply system involves the selection, the procurement storage
and the distribution / utilization of drugs and other supplies.

B. What is a store? A store is a place or space (warehouse) where stocks are for maintenance
purpose until they are distributed. A store or storeroom has two main purposes.

1. To keep drugs and supplies in acceptable condition (quality and quantity)

2. To ensure prompt and efficient distribution of supplies when needed
3. (Emergency)

Stores may be established at three (3) different levels

1. International level
2. National level
3. Health facility level

No matter the level, all storerooms have three main functions:

1. Receiving items;
2. Keeping track of them while in stock; and
3. Distributing said items as required

QUESTION

1. What is storeroom Management?

2. What is a store?
3. What is a stock?
4. What are the two main purpose of establishing a storeroom?

METHODS OF KEEPING YOUR STOCK IN GOOD CONDITION

While in the facility store, the drugs and medical supplies must be protected from sunlight, heat
moisture, thefts, expiration, dirt, fire hazard and physical
37

HEAT AND SUNLIGHT ……. Avoid direct sunlight and heat build – up in your store heat.
You must ensure that your store has between shelves, cartons; boxes, etc. keep all containers
tightly closed. Avoid occupying a shelf with excess items.

MOISTURE – in order to keep moisture from setting on drugs and other supplies, keep the items
in your storeroom in dry places. Keep the window of the storeroom open during working hours;
provide enough spaces between shelves, cartoons, boxes, etc. keep all containers tightly closed.
Avoid occupying a shelf with excess items.

Pests – termites, rats and insects (ants, roaches, etc). are dangerous in a storeroom. They must
therefore be away from storeroom. You can do this by using certain pets control methods as long
as it does not pose danger to the stock. But most importantly, keeping your storeroom clean;
closing hole in walls, floor or ceiling can drive pests away from your stock.
38

9.0 The Logistic Cycle

4 mechanism of needed for the logistic cycle to function

Strategized planning – long range planning

Financial management: have people to take care of finance
Human Resource Mgt: proper use of manpower
Information Mgt: information should be spread to all

 THE LOGISTIC CYCLE IS:

- An essential part of P.H.C
- A systematic approval is possible and useful
- A variety of specific technical skills are needed
- Prime objective is to use limited resource effectively

1. Selection (concentrates on basic essential drug)

 Basic essential drugs: are those drugs that satisfy the health care reads of the majority
of the population, based on the most common local diseases and condition and on the
39

capability of the health workers who use then at the difference of the health care
system due considering for availability

2. Procurement: thee part of the process after you have selected the right types of drugs
and supplies.

3. Distribution: This part involves ensuring that health facilities receives the needed drugs
based upon their rate of consumption (quota System)

4. Use: This portion ensures that the received drug is rationally or wisely used by both the
practitioner and the patients.

BASIC ESSENTIAL DRUG: Are those drugs that satisfy the health care needs of the majority of
the population based on the most common local diseases, conditions and on the capability of the
health worker who use the drug at the different levels of the health care system with due
consideration of availability, cost of treatment, safety of drugs and therapeutic effective.

 Based planning and management often cause the limited drug finds to be spend on
ineffective, duplicative or unacceptably dangerous drug.

W.H.O Guidelines for Basic Essential Drugs says that:

1. Your selection should be based on scientific proof
40

10.0 Applying infectious Diseases to P.H.C.

Objective
1. Basic reason for P.H.C
2. List some infectious diseases
3. List some P. H. C. concepts / principles of infectious diseases
4. Discuss the parts of an epidemiologic triangle
5. What are some categories

3 basic objective of PHC

1. Incidence and providence of disease (incidence – now) (prevalence – now and the past
over a period)
2. Improved health of families and communities
3. To improve the physical quality of life. This is by applying what you learn to yourself.

Rationale or justification
1. Most of the diseases treated at the health facility can be prevented by simple
interventions.

2. Inequality in the health status of people

- Between developed and developing community
- Between urban and rural community
- Between poor & rich urban county

3. In equitable distribution of health resources

4. Lack of community involvement

5. Examples from Europe & America showed improvement by the discovery of penicillin
(Antibiotics) in 1928 in St. Mary Hospital by Sr. Alexander Flaming in Britian.

They put emphasis on sanitation and environmental health

1. Safe drinking H20

2. Good education improved educational standards
41

3. Environmental sanitation (charging he environment in favor of the host and at the

deferment of the agent). Domestic waste disposal
4. Good housing condition
5. Proper food handling
6. Proper nutritional promotion
7. M.C.H(immunization)
8. Good roads
9. Good communication system
10. Health education

Some concepts used in applying infectious to P.H.C

1. Receptive framework: selling your idea to the community,

- Establishment - making them interested, involving the community leaders, influential
people and traditional leaders.

2. Community involvement: this must start from the conceptualization and spread to all
levels

3. Decentralization: delegation of responsibility

4. Multi - disciplinary approach: using the expertise of community members

5. Re – definition of roles because of community involvement individual must be redefined.

6. Appropriate training: Tracy for both health workers and community members

7. Supportive supervision: your supervision should be supportive informative educative and

reinforcing.
42

Using the Epidemiologic Triangle of Infectious disease control

Resistance (immunity)

What makes a strong resistance?

- Nutrition
- Immunization
- Age
- Exercise
- Germs
- Parasites virulence (how strong)

The hosts are fund in

1. Dwelling place
2. Market places / business center
3. Industries
4. Training institutions
5. On the farm
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Also in the environment we have (air, water, and people). In the environment the host always
wants to alter the environment. If the change is (-) the host is affected and when it is (+) the host
benefits.

Before you talk (tell, discuss, dialogue or educate) know the following:
1. What to say
2. How to say it
3. What you can do
4. Know what the community should do

ASSIGNEMNT
Group I

Group II

Group III

Group IV

Resources in the community

a. Tangible resources (see, touch or feel) b. Intangible

- Water - ideas / wisdom
- Wood and wood products - knowledge
- Earth / soil - authority
- Ropes - system
- Manpower - social system
- Money - culture / norms
- Food - behavior
- Houses - talents
- Social groups - potential
- Car / road - unity
- Air - will power
(determination)
- Leader - influence
- Working tool - time
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Typhoid Fever
Host

1. Protect some of
H20
2. Protect food from infection
(Do domestic & Personal Hygiene)

3. Community’s Pt referred
4. Isolation
5. Health certificate for
Food handlers

Agent (1) H20 PX Environment

(S. Typhi) Proper waste disposal (food, water)

3 new added approach of P.H.C

6. Community involvement
7. Multi – sectoral approach
8. Systematic approach